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Reliability of pleural fluid lymphocyte counts in the antenatal diagnosis of congenital chylothorax.
Eddleman KA, Levine AB, Chitkara U, Berkowitz RL.
Department of Obstetrics, Gynecology, and Reproductive Sciences, Mount Sinai Medical Center, New York, New York.
Two cases are presented in which fetal thoracentesis was performed to evaluate pleural effusions. In the first, a fetus with nonimmune hydrops had pleural effusions with lymphocyte counts consistent with congenital chylothorax. However, amniotic fluid cultures grew cytomegalovirus and the diagnosis of congenital cytomegalovirus infection was confirmed at autopsy. In the second, the pleural fluid lymphocyte count was lower than that considered to be diagnostic of congenital chylothorax. Nevertheless, the clinical course in this case and the patient's history of two previous infants who were presumed to have that disease suggest that this was the most likely diagnosis. These cases emphasize that pleural fluid lymphocyte counts alone are not reliable in establishing the cause of hydrothorax before birth.
Publication Types:
PMID: 1651466 [PubMed - indexed for MEDLINE]
Congenital chylothorax in neonatal thyrotoxicosis.
Ibrahim H, Asamoah A, Krouskop RW, Lewis D, Webster P, Pramanik AK.
Department of Pediatrics, Louisiana State University School of Medicine-Shreveport, USA.
We report a patient with congenital chylothorax who also had neonatal thyrotoxicosis secondary to maternal Graves' disease. Fetal tachycardia with hydrops was detected at 28 weeks' gestational age. The fetus responded to antithyroid medication in utero but had persistent bilateral pleural effusion. At birth, he had respiratory distress due to massive pleural effusion. Cytologic studies of pleural fluid were consistent with chylothorax. To the best of our knowledge, the association of congenital chylothorax with fetal (neonatal) thyrotoxicosis, has not been reported previously.
Publication Types:
PMID: 10685206 [PubMed - indexed for MEDLINE]
Congenital chylothorax presenting as hydrops fetalis. A case report.
Sacks LM, Polin JI, Breckenridge J.
Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia.
A case of congenital chylothorax presented as polyhydramnios and massive fetal edema. The diagnosis was suspected prior to delivery on the basis of ultrasonography. Ultrasound was helpful in localizing the fluid for postnatal thoracentesis. Congenital chylothorax is part of the differential diagnosis of nonimmune hydrops fetalis.
Publication Types:
PMID: 6152989 [PubMed - indexed for MEDLINE]
Fetal therapy and cytogenetic testing: prenatal detection of chromosome aberration during thoracocentesis for congenital chylothorax by karyotyping from pleural effusion fluid and review of the literature.
Chen CP.
Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China. [email protected]
This report serves to emphasize the necessity of rapid cytogenetic testing during fetal therapy for congenital hydrothorax and to review the literature. A 31-year-old primigravid woman was noted to have bilateral fetal hydrothorax, polyhydramnios, and preterm labor at 32 weeks' gestation. Echo-guided thoracocentesis was performed to draw 50 ml of golden/yellow pleural effusion fluid and 500 ml of amniotic fluid. Cytogenetic analysis of the lymphocytes obtained from the pleural effusion fluid revealed a karyotype of 47, XY, + 21. The pleural effusion fluid was predominantly lymphocytic and positive for the Rivalta test. A sonographic examination at 33 weeks' gestation revealed recurrent pleural effusion, but the woman refused repeat thoracocentesis and tocolytic management. A 2,568-g male baby with characteristic phenotypic findings of Down syndrome was delivered vaginally and expired after birth. The present case reinforces the notions that fetuses with congenital chylothorax are at risk for chromosomal abnormalities, and drainage of pleural effusion must include a rapid diagnosis of fetal karyotype. The cytogenetic information acquired is useful for genetic counseling and perinatal obstetric management.
Publication Types:
PMID: 16259328 [PubMed - indexed for MEDLINE]
Massive edema and bilateral pleural effusions in a newborn infant.
Zito L, Keszler M.
Department of Pediatrics, Georgetown University, Washington, DC.
Publication Types:
PMID: 2802264 [PubMed - indexed for MEDLINE]
Transient hydrops fetalis associated with intrauterine cytomegalovirus infection: prenatal diagnosis.
Mazeron MC, Cordovi-Voulgaropoulos L, Perol Y.
Service de Bacteriologie-Virologie, Hopital Lariboisiere, Universite Paris VII, France.
BACKGROUND: Intrauterine cytomegalovirus infection is usually unrecognized during pregnancy. However, in some cases, ultrasound abnormalities can be observed in association with cytomegalovirus infection. CASE: The prenatal diagnosis of cytomegalovirus infection in a fetus with transient hydrops is reported. Fetal ascites was first recognized by routine ultrasound examination at 20 weeks' gestation. Hydrops fetalis was obvious at 23 weeks and completely resolved 1 week later. Cytomegalovirus was detected from amniotic fluid samples by centrifugal culture and direct immunofluorescent examination. The diagnosis of maternal primary infection could be established retrospectively by demonstrating immunoglobulin (Ig) G and IgM seroconversion on sequential sera. The pregnancy was electively terminated. Autopsy findings were consistent with fetal disseminated infection. CONCLUSION: Transient hydrops fetalis in association with intrauterine cytomegalovirus infection is infrequent. The resolution of hydrops fetalis could be explained by hepatic dysfunction of limited duration. Amniotic fluid culture is a reliable approach for diagnosing intrauterine cytomegalovirus infection, but does not predict the severity of the disease or the outcome of the pregnancy. The long-term clinical significance of intrauterine cytomegalovirus infection has to be established.
Publication Types:
PMID: 9205451 [PubMed - indexed for MEDLINE]
Intrauterine diagnosis of hydrothorax in a fetus who had a combination chylothorax and pulmonary sequestration after delivery.
Shipley CF 3rd, Simmons CL, Nelson GH.
University of South Carolina School of Medicine, Department of Obstetrics and Gynecology, Columbia, USA.
Congenital hydrothorax was diagnosed prenatally by transabdominal ultrasonography. Five fetal thoracentesis procedures were performed and biochemical analyses of the fluids were done. After delivery a combination chylothorax and extralobar pulmonary sequestration was demonstrated in the infant. We believe this to be the first case report of this combination investigated prenatally. We suggest that investigators perform biochemical analyses on fetal pleural fluid removed in cases with a single diagnosis. Perhaps by comparing those data with the data reported here, a biochemical marker can be identified that will be useful in distinguishing these two conditions in utero.
PMID: 7666275 [PubMed - indexed for MEDLINE]
Congenital chylothorax in a patient with 21 trisomy syndrome.
Yamamoto T, Koeda T, Tamura A, Sawada H, Nagata I, Nagata N, Ito T, Mio Y.
Division of Child Neurology, Faculty of Medicine, Tottori University, Japan.
A female infant with 21 trisomy syndrome associated with congenital chylothorax was reported. She was born at a gestational age of 34 weeks by Cesarean section because of fetal hydrothorax and hydrops fetus, confirmed by ultrasonography at 32 weeks. Emergent resuscitation and immediate thoracentesis were performed soon after birth. After beginning breast feeding, the serous pleural fluid became opalescent and a diagnosis of congenital chylothorax was made. Feeding was changed to medium-chain triglyceride (MCT) feeding and the production of pleural effusion disappeared after thoracentesis was performed several times. Accumulating evidence suggested that MCT feeding and intermittent thoracentesis under echo guide were effective. Some reports on patients, including this one, suggest that there may be more patients with 21 trisomy associated with congenital hydrothorax. Therefore, congenital hydrothorax might be listed as a complication of 21 trisomy.
Publication Types:
PMID: 9002311 [PubMed - indexed for MEDLINE]
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